Abnormal Psychology and Culture-Bound Syndromes
As many of us know, there are unlimited differences in cultures around the world from religion to the way we communicate with one another. What many of us may not know, however, is that there are actually specific psychological disorders found only in certain areas of the world. There are several well known culture-bound disorders as well as variances in disorders and on theoretical reasons behind the disorders themselves that will be discussed throughout.
To be clear, not all of the strange things people do all over the world are disorders nor are culture-bound syndromes limited to any one region. Anorexia/bulimia nervosa, for example, is a disorder found in the west but not in Third World countries. This could be due to the differences in emphasis the cultures put on thinness of women in the media or feelings of a need to be in control (Matsumoto, 1994). Just north of the U.S., there are the Algonquin Indians in Canada who are unique in having a disorder among them called witiko. Witiko is a delusional disorder that involves the belief that one has been possessed by a man-eating monster. Oftentimes the person suffering will commit suicide before acting on these cannibalistic impulses (Matsumoto, 1994). Witiko is a rare example of a culture-bound syndrome found in Indian culture. Many of their practices are centered on spiritual communication and therefore not considered abnormal or disorders. Arctic Hysteria is another culture-bound syndrome that falls in the somatoform category of disorders. Arctic Hysteria is only found in Alaska, and the
symptoms include dissociative episodes with extreme excitement and are often followed by grand mal seizures and comas (Simons, 2001). Moving on to eastern cultures, specifically Southeast Asia and Pacific Island areas, there is what is known as amok. Amok is a dissociative disorder in which a person is said to enter a trance like state, become highly excited, and start attacking things, whether they be people or just objects (Nevid, Rathus, Greene, 2006). This is where the phrase Ð²Ð‚?running amuckÐ²Ð‚â„¢ comes from. The last two culture-bound syndromes to be mentioned are somatoform disorders found primarily in Asian and Indian males. Koro is impotence resulting from the fear that the penis is shrinking (Matsumoto, 1994), and dhat syndrome is the intense fear or anxiety of losing semen through nocturnal emissions or even urination (Nevid, Rathus, Greene, 2006). To the men of India semen is the elixir of life, and it provides health and longevity. With that being said, it is not hard to imagine how these men might develop this fear when a commonly held Hindu belief is it takes Ð²Ð‚Ñš forty meals to form one drop of blood; forty drops of blood to fuse and form one drop of bone marrow, and forty drops of this to form one drop of semen.Ð²Ð‚Ñœ (Nevid, Rathus, Greene, 2006). If my math is correct, this means that a man will make about 1 drop of semen every 59 years.
An interesting thing to point out with culture-bound syndromes is that there is a level of understanding of a specific culture needed before any help can be administered. As with all cultures and people, everyone is brought up thinking a certain way and doing certain things. For an outsider with their own views and beliefs to go in and try to fix a problem-well that could be a problem in itself. For example, in the case of amok, it seems that it is entirely predictable that people would go around having crazy homicidal outbursts because that aggressive behavior Ð²Ð‚Ñšbroadly follows the patterns of societal expectations.Ð²Ð‚Ñœ (Matsumoto, 1994, p.143). As for the
people with the shrinking penis disorder, this could be due to their cultureÐ²Ð‚â„¢s specific emphasis on paternal authority (Matsumoto, 1994). Koro is found in Asian males which makes perfect sense from what little I know about Asian culture. I know it is a very respectful one with much emphasis on elders, specifically men. Anorexia or bulimia would be interesting disorders to try to explain to person in a Third World Country or, better yet, a small tribe somewhere where they do not even bother with clothes. These types of things are so specific that they are almost incomprehensible to those not brought up with them. Another factor of a culture-bound syndrome is how the culture will react to it (Matsumoto, 1994). In susto a person suffers from depression thought to be caused from Ð²Ð‚Ñšsoul lossÐ²Ð‚Ñœ (Matsumoto, 1994). When this happens to a person, a native healer will carry out sacrifices to the earth in attempts to get the soul back (Matsumoto, 1994). This could easily be a subconscious way to involve oneÐ²Ð‚â„¢s self with his community or get some attention or any number of things. All of these reasons are why it is important to have a good grasp on the culture of where a person is coming from. Since the DSM-IV has been updated to include about 25 culture-bound syndromes, there has also been added an Ð²Ð‚ÑšOutline for Cultural FormationÐ²Ð‚Ñœ (Smith & Smith, 1997). This outline is to help get a solid feel of a personÐ²Ð‚â„¢s cultural background. The five categories are Ð²Ð‚Ñš1) Cultural identity of the individual. 2) Cultural explanation of the individualÐ²Ð‚â„¢s illness. 3) Cultural factors related to psychosocial environment and levels of functioning. 4) Cultural elements of the relationship between the individual and the clinician. 5) Overall cultural assessment for diagnosis and care. (Smith & Smith,1997)Ð²Ð‚Ñœ The DSM-IV added culture-bound syndromes it thought were common enough to see in America (Smith & Smith,1997) and hopefully that will prove to be enough cultural diversity for now. These disorders and the insight they give us into different parts of the
world are very interesting and unique, but they do not stop there. What about cross cultural differences in disorders that are not so mystical and rare?
The two most extensively studied cross cultural disorders are depression and schizophrenia (Matsumoto, 1994). In a specific study of schizophrenia that included Columbia, Czechoslovakia, Denmark, England, Nigeria, the Soviet Union, Taiwan, and the United States all of these countries shared common symptoms (Matsumoto, 1994). However, the study showed that people in developing countries tended to recuperate faster than those in highly industrialized countries, perhaps due to the tendency to go back to work in developing places (Matsumoto, 1994). Things such as auditory or visual hallucinations must be taken into consideration as well when thinking of schizophrenia. Depending on where you are, seeing or hearing things could be a completely normal part of your day. In Nigeria it is much more accepted to hear voices than it would be in the United States, so it is not surprising that in this study it was found that Nigerian people suffering from schizophrenia complained of that symptom more than others (Matsumoto, 1994). Danish patients and Nigerians also were more likely to enter states of catatonia in the study (Matsumoto, 1994). In another study of schizophrenia around the world, a guy named Murphy (1982) found that admission rates for schizophrenia were much higher in Ireland than in Wales and he attributed this to IrelandÐ²Ð‚â„¢s culture of (sharp wit, ambivalence toward individuality) (Matsumoto, 1994). In yet another study, this one of New York psychiatric cases by Opler and Singer (1959) they found that Ð²Ð‚ÑšIrish-American schizophrenic patients were more likely to experience paranoid delusions than were Italian-American schizophrenic patients. (Matsumoto, 1994)Ð²Ð‚Ñœ A study of Japanese schizophrenic patients found that they are more likely to be Ð²Ð‚Ñšwithdrawn and passive than Euro-Americans in conformity to cultural valuesÐ²Ð‚Ñœ (Matsumoto,
1994). All of these differences and variations on the same disorder lead back to one thing, culture. How people are raised and where and when has to have so much to do with how we turn out it is amazing. Another interesting bit of research that was done, but not able to be done on a wide scale is the effect of expressed emotion on patients with schizophrenia. Not surprisingly expressed emotion was shown to hinder the healing process and increase the risk of relapses in patients in Western culture (Matsumoto, 1994). What would be interesting though, is if there could be research done on more cultures with the expressed emotions, specifically the non-verbal cultures or where family is less intimate. The other well studied cross cultural disorder is depression. Everyone feels depressed now and again, that is old news, but how we feel depressed may be new. Certain cultural groups are prone to acting a certain way, for example a culture that focuses on individualism will have people that feel lonely or sad and so on. On the other hand there are some cultures that do not even have words for Ð²Ð‚?lonelyÐ²Ð‚â„¢ or Ð²Ð‚?sadÐ²Ð‚â„¢, so how would they know if they were. In cultures that do not have such words or do not speak of depression, a person might complain of a pain somewhere in the body that would ultimately be caused by the same thing (Matsumoto, 1994). In studies it has been found that Nigerians are not very likely to experience feelings of worthlessness and also that Chinese are likely to experience somatic complaints (Matsumoto, 1994). This could be an example of an individualistic culture where people get lonely and sad feelings and then the aches and pains start in.
From culture-bound syndromes to cultural variances of well known disorders there is still much research to be done. So much is left unknown about the lives and troubles of people all over the world and the amazing occurrences of culture-bound syndromes. We do know that religion, family, lifestyle, community, biology and countless other factors play roles in the cause
of disorders. The world is full of too much information to focus on one small section and the more we learn from others the more we gain. The few differences in schizophrenia and depression that were mentioned were somewhat minor, but their existence just proves even further how diverse every little section of this earth is from every other little section and we have that much more to learn.